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【目的】ハンドアシスト法を併用した後腹膜鏡補助下腎尿管全摘除術の治療成績を検討した.【対象と方法】腎盂尿管腫瘍の42例を対象とした.腎摘位で,7cmの傍腹直筋切開から後腹膜腔に到達し,ハンドアシスト法により鏡視下に腎摘除術を行った.原則的に下部尿管の処理は傍腹直筋部の7cmの創から直視下に行い,同時にもう1人の術者が経尿道的に尿管口周囲を切開し,傍腹直筋切開部から摘出した.【結果】手術時間は平均229分,出血量は平均247mlであった.合併症は4例(10%)に認め,開腹術への移行を1例に認めた.【結論】ハンドアシスト法を併用した後腹膜鏡補助下腎尿管全摘除術は,有用で安全な術式と考えられた.
Objectives: We report our experience of hand assisted retroperitoneoscopic total nephroureterectomy.
Patients and methods: Forty two consecutive patients with renal pelvic or ureteral tumor underwent this procedure. Under nephrectomy position, removal of the kidney was performed retroperitoneally with a hand placed through a pararectal longitudal 7 cm incision. Ureterectomy and transurethral excision of the bladder cuff and the intramural ureter were performed at the same time by two operators. Ureterectomy was per-formed through the 7 cm pararectal incision in which the hand had been inserted.
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